An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms

2013 ◽  
Vol 34 (5) ◽  
pp. 459-465 ◽  
Author(s):  
Brett Sitzlar ◽  
Abhishek Deshpande ◽  
Dennis Fertelli ◽  
Sirisha Kundrapu ◽  
Ajay K. Sethi ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Ultraviolet Radiation ◽  
Baseline Period ◽  
Veterans Affairs ◽  
Fluorescent Marker ◽  
Fluorescent Markers ◽  
Tiered Interventions ◽  
Cleaning And Disinfection ◽  
The Impact ◽  
Environmental Disinfection

Objective.Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning.Design.Prospective intervention.Setting.A Veterans Affairs hospital.Interventions.During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection.Results.The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P = .024), 48% (P>.001), and 89% (P = .006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively.Conclusions.An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.

A Multicenter Randomized Trial to Determine the Effect of an Environmental Disinfection Intervention on the Incidence of Healthcare-Associated Clostridium difficile Infection

2017 ◽  
Vol 38 (7) ◽  
pp. 777-783 ◽  
Author(s):  
Amy J. Ray ◽  
Abhishek Deshpande ◽  
Dennis Fertelli ◽  
Brett M. Sitzlar ◽  
Priyaleela Thota ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Randomized Trial ◽  
Primary Outcome ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Fluorescent Marker ◽  
Multicenter Randomized Trial ◽  
Healthcare Associated ◽  
The Impact ◽  
Environmental Disinfection

OBJECTIVETo determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).DESIGNA multicenter randomized trial.SETTINGIn total,16 acute-care hospitals in northeastern Ohio participated in the study.INTERVENTIONWe conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.RESULTSOverall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.CONCLUSIONSAn environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.Infect Control Hosp Epidemiol 2017;38:777–783

The Impact of a Computerized Clinical Decision Support Tool on Inappropriate Clostridium difficile Testing

2017 ◽  
Vol 38 (10) ◽  
pp. 1204-1208 ◽  
Author(s):  
Duncan R. White ◽  
Keith W. Hamilton ◽  
David A. Pegues ◽  
Asaf Hanish ◽  
Craig A. Umscheid
Keyword(s):  
Decision Support ◽  
Clostridium Difficile ◽  
Clinical Decision Support ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Baseline Period ◽  
Support Tool ◽  
Number Of Patients ◽  
The Impact ◽  
Order Set

OBJECTIVETo evaluate the effectiveness of a computerized clinical decision support intervention aimed at reducing inappropriate Clostridium difficile testingDESIGNRetrospective cohort studySETTINGUniversity of Pennsylvania Health System, comprised of 3 large tertiary-care hospitalsPATIENTSAll adult patients admitted over a 2-year periodINTERVENTIONProviders were required to use an order set integrated into a commercial electronic health record to order C. difficile toxin testing. The order set identified patients who had received laxatives within the previous 36 hours and displayed a message asking providers to consider stopping laxatives and reassessing in 24 hours prior to ordering C. difficile testing. Providers had the option to continue or discontinue laxatives and to proceed with or forgo testing. The primary endpoint was the change in inappropriate C. difficile testing, as measured by the number of patients who had C. difficile testing ordered while receiving laxatives.RESULTSCompared to the 1-year baseline period, the intervention resulted in a decrease in the proportion of inappropriate C. difficile testing (29.6% vs 27.3%; P=.02). The intervention was associated with an increase in the number of patients who had laxatives discontinued and did not undergo C. difficile testing (5.8% vs 46.4%; P<.01) and who had their laxatives discontinued and underwent testing (5.4% vs 35.2%; P<.01). We observed a nonsignificant increase in the proportion of patients with C. difficile related complications (5.0% vs 8.9%; P=.11).CONCLUSIONSA C. difficile order set was successful in decreasing inappropriate C. difficile testing and improving the timely discontinuation of laxatives.Infect Control Hosp Epidemiol 2017;38:1204–1208

scholarly journals Marcadores fluorescentes para o monitoramento da limpeza e desinfecção de superficies

2019 ◽  
Vol 13 (5) ◽  
pp. 1495
Author(s):  
Aires Garcia Dos Santos Junior ◽  
Danilo Fernando Gonçalves Gonzaga ◽  
Neliendy Gricolo Barbosa ◽  
Marcelo Alessandro Rigotti ◽  
Mara Cristina Ribeiro Furlan ◽  
...  
Keyword(s):  
Fluorescent Dyes ◽  
Surface Cleaning ◽  
Virtual Library ◽  
Equipment Contamination ◽  
Fluorescent Markers ◽  
Accurate Indication ◽  
Study Type ◽  
Cleaning And Disinfection ◽  
Hospital Cleaning ◽  
The Impact

RESUMO Objetivo: descrever o uso de marcadores fluorescentes para o monitoramento da limpeza e a desinfecção de superfícies. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, realizado a partir das bases de dados LILACS, MEDLINE e na biblioteca virtual SciELO. Incluiram-se artigos nas línguas portuguesa, inglesa e espanhola, sem delimitação de período. Selecionaram-se, a partir da análise crítica dos resumos, dez (100%) artigos. Apresentaram-se os resultados em forma de figuras. Resultados: relata-se, com relação à caracterização dos artigos analisados, que quatro (40%) foram publicados no ano de 2008. Nota-se que sete (70%) apresentam como objetivo avaliar e melhorar as práticas de limpeza em diversos ambientes. Conclusão: sugerem-se novos estudos que vislumbrem demostrar o impacto de intervenções na limpeza com os indicadores de segurança do paciente, permitindo apontar exatamente os ganhos ao paciente. Descritores: Corantes Fluorescentes; Desinfecção; Serviço Hospitalar de Limpeza; Gestão da Qualidade; Auditoria de Enfermagem; Contaminação de Equipamentos.ABSTRACT Objective: to describe the use of fluorescent markers to monitor surface cleaning and disinfection. Method: this is a bibliographical study, type integrative review, carried out from LILACS, MEDLINE and the SciELO virtual library. Portuguese, English and Spanish articles were included, without delimitation of period. From the critical analysis of the abstracts, ten (100%) articles were selected. The results were presented in the form of figures. Results: four (40%) were published in the year 2008. It is noteworthy that seven (70%) have the objective of evaluating and improving cleaning practices in several environments. Conclusion: new studies are suggested that demonstrate the impact of cleaning interventions with the patient's safety indicators, allowing an accurate indication of the gains to the patient. Descriptors: Fluorescent dyes; Disinfection; Hospital Cleaning Service; Quality management; Nursing Audit; Equipment Contamination. RESUMEN Objetivo: describir el uso de marcadores fluorescentes para el monitoreo de la limpieza y la desinfección de superficies. Método: se trata de un estudio bibliográfico, tipo revisión integrativa, realizado a partir de las bases de datos LILACS, MEDLINE y en la biblioteca virtual SciELO. Se incluyeron los artículos en portugués, Inglés y Español sin periodo de delimitación. Se seleccionaron, a partir del análisis crítico de los resúmenes, diez (100%) artículos. Se presentaron los resultados en forma de figuras. Resultados: se relata, con relación a la caracterización de los artículos analizados, que cuatro (40%) fueron publicados en el año 2008. Se nota que siete (70%) presentan como objetivo evaluar y mejorar las prácticas de limpieza en diversos ambientes. Conclusión: se sugieren nuevos estudios que vislumbre demostrar el impacto de intervenciones en la limpieza con los indicadores de seguridad del paciente, permitiendo apuntar exactamente las ganancias al paciente. Descriptores: Colorantes Fluorescentes; Desinfección; Servicio de Limpieza en Hospital; Gestión de la Calidad; Auditoria de Enfermería; Contaminación de Equipos.

A Fused Thiophene-S,S-Dioxide-Based Super-Photostable Fluorescent Marker for Lipid Droplets

2020 ◽  
Author(s):  
Masayasu Taki ◽  
Keiji Kajiwara ◽  
Eriko Yamaguchi ◽  
Yoshikatsu Sato ◽  
Shigehiro Yamaguchi
Keyword(s):  
Small Molecules ◽  
Lipid Droplets ◽  
Trajectory Analysis ◽  
Super Resolution ◽  
Fluorescent Marker ◽  
Selective Staining ◽  
Fluorescent Markers ◽  
Biological Studies ◽  
Particle Level

Lipid droplets (LDs) are essential organelle in most eukaryotes, and tracking intracellular LDs dynamics using synthetic small molecules is crucial for biological studies. However, only a limited number of fluorescent markers that satisfy all requirements, such as the selective staining of LDs, high photostability, and sufficient biocompatibility, have been developed. Herein, we report a series of donor-p-acceptor dyes based on the thiophene-containing fused polycyclic scaffold [1]benzothieno[3,2-<i>b</i>][1]benzothiophene (BTBT), in which either or both thiophene rings are oxidized into thiophene-<i>S</i>,<i>S</i>-dioxide to form an electron-accepting building block. Among these dyes, LAQ1 satisfied all the aforementioned requirements, and allowed us capturing ultra-small LDs on the endoplasmic reticulum (ER) membrane by stimulation emission depletion (STED) microscopy with a super-resolution below the diffraction limit of light. Moreover, the extremely high photostability of LAQ1 enabled recording the lipolysis of LDs and the concomitant lipogenesis as well as long-term trajectory analysis of micro LDs at the single particle level in living cells.

The Impact of Ultraviolet Radiation on Barrier Function in Human Skin: Molecular Mechanisms and Topical Therapeutics

2019 ◽  
Vol 25 (40) ◽  
pp. 5503-5511 ◽  
Author(s):  
Abdulaziz Alhasaniah ◽  
Michael J. Sherratt ◽  
Catherine A. O'Neill
Keyword(s):  
Ultraviolet Radiation ◽  
Barrier Function ◽  
Molecular Mechanisms ◽  
Transepidermal Water Loss ◽  
Protective Effects ◽  
Barrier Dysfunction ◽  
Epidermal Barrier ◽  
Positive Effects ◽  
Terrestrial Mammals ◽  
The Impact

A competent epidermal barrier is crucial for terrestrial mammals. This barrier must keep in water and prevent entry of noxious stimuli. Most importantly, the epidermis must also be a barrier to ultraviolet radiation (UVR) from the sunlight. Currently, the effects of ultraviolet radiation on epidermal barrier function are poorly understood. However, studies in mice and more limited work in humans suggest that the epidermal barrier becomes more permeable, as measured by increased transepidermal water loss, in response UVR, at doses sufficiently high to induce erythema. The mechanisms may include disturbance in the organisation of lipids in the stratum corneum (the outermost layer of the epidermis) and reduction in tight junction function in the granular layer (the first living layer of the skin). By contrast, suberythemal doses of UVR appear to have positive effects on epidermal barrier function. Topical sunscreens have direct and indirect protective effects on the barrier through their ability to block UV and also due to their moisturising or occlusive effects, which trap water in the skin, respectively. Some topical agents such as specific botanical extracts have been shown to prevent the loss of water associated with high doses of UVR. In this review, we discuss the current literature and suggest that the biology of UVR-induced barrier dysfunction, and the use of topical products to protect the barrier, are areas worthy of further investigation.

scholarly journals The Impact of Ultraviolet Radiation on the Aetiology and Development of Uveal Melanoma

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1700
Author(s):  
Melissa Chalada ◽  
Charmaine A. Ramlogan-Steel ◽  
Bijay P. Dhungel ◽  
Christopher J. Layton ◽  
Jason C. Steel
Keyword(s):  
Risk Factors ◽  
Ultraviolet Radiation ◽  
Uveal Melanoma ◽  
World Health Organisation ◽  
World Health ◽  
Genetic Mutations ◽  
High Incidence ◽  
The World ◽  
The Impact

Uveal melanoma (UM) is currently classified by the World Health Organisation as a melanoma caused by risk factors other than cumulative solar damage. However, factors relating to ultraviolet radiation (UVR) susceptibility such as light-coloured skin and eyes, propensity to burn, and proximity to the equator, frequently correlate with higher risk of UM. These risk factors echo those of the far more common cutaneous melanoma (CM), which is widely accepted to be caused by excessive UVR exposure, suggesting a role of UVR in the development and progression of a proportion of UM. Indeed, this could mean that countries, such as Australia, with high UVR exposure and the highest incidences of CM would represent a similarly high incidence of UM if UVR exposure is truly involved. Most cases of UM lack the typical genetic mutations that are related to UVR damage, although recent evidence in a small minority of cases has shown otherwise. This review therefore reassesses statistical, environmental, anatomical, and physiological evidence for and against the role of UVR in the aetiology of UM.

Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms

2021 ◽  
pp. 1-5
Author(s):  
Jennifer L. Cadnum ◽  
Basya S. Pearlmutter ◽  
Annette L. Jencson ◽  
Hanan Haydar ◽  
Michelle T. Hecker ◽  
...  
Keyword(s):  
Bacterial Pathogens ◽  
Outpatient Clinics ◽  
Acinetobacter Baumanii ◽  
Healthcare Facilities ◽  
Fluorescent Markers ◽  
Clostridioides Difficile ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Cleaning And Disinfection ◽  
Surgery Center

Abstract Objective: To investigate the frequency of environmental contamination in hospital areas outside patient rooms and in outpatient healthcare facilities. Design: Culture survey. Setting: This study was conducted across 4 hospitals, 4 outpatient clinics, and 1 surgery center. Methods: We conducted 3 point-prevalence culture surveys for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridioides difficile, Candida spp, and gram-negative bacilli including Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumanii, and Stenotrophomonas maltophilia in each facility. In hospitals, high-touch surfaces were sampled from radiology, physical therapy, and mobile equipment and in emergency departments, waiting rooms, clinics, and endoscopy facilities. In outpatient facilities, surfaces were sampled in exam rooms including patient and provider areas, patient bathrooms, and waiting rooms and from portable equipment. Fluorescent markers were placed on high-touch surfaces and removal was assessed 1 day later. Results: In the hospitals, 110 (9.4%) of 1,195 sites were positive for 1 or more bacterial pathogens (range, 5.3%–13.7% for the 4 hospitals) and 70 (5.9%) were positive for Candida spp (range, 3.7%–5.9%). In outpatient facilities, 31 of 485 (6.4%) sites were positive for 1 or more bacterial pathogens (range, 2% to 14.4% for the 5 outpatient facilities) and 50 (10.3%) were positive for Candida spp (range, 3.9%–23.3%). Fluorescent markers had been removed from 33% of sites in hospitals (range, 28.4%–39.7%) and 46.3% of sites in outpatient clinics (range, 7.4%–82.8%). Conclusions: Surfaces in hospitals outside patient rooms and in outpatient facilities are frequently contaminated with healthcare-associated pathogens. Improvements in cleaning and disinfection practices are needed to reduce contamination.

scholarly journals Perioperative Microbial Contamination From Patients on Contact Precaution in Operating Room Environment

2020 ◽  
Vol 41 (S1) ◽  
pp. s348-s349
Author(s):  
Hajime Kanamori ◽  
William Rutala ◽  
Maria Gergen ◽  
David Jay Weber
Keyword(s):  
Small Computer ◽  
Contact Precaution ◽  
Time Points ◽  
Contact Precautions ◽  
Surgery Patient ◽  
Patient Arrival ◽  
The Mean ◽  
Healthcare Associated ◽  
Cleaning And Disinfection ◽  
The Impact

Background: The contaminated healthcare environment, including operating rooms (ORs), can serve as an important role in transmission of healthcare-associated pathogens. Studies are very limited regarding the level of contamination of ORs during the surgery of a patient on contact precautions and the risk to the next surgery patient after standard room cleaning and disinfection. Objective: Here, we investigated the microbial burden on the OR environment when patients on contact precautions receive surgery, and we assessed the impact of cleaning and disinfection on the contamination of OR environmental sites. Methods: This investigation was conducted in the ORs of an academic facility during an 8-month period. It involved 10 patients on contact precautions for multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA; n = 7); carbapenem-resistant Enterobacteriaceae (CRE) plus MRSA (n = 2); and vancomycin-resistant Enterococcus (VRE) plus MRSA (n = 1), who underwent surgery. Environmental sampling was performed at the following time points: (1) immediately before the surgical patient’s arrival in the OR, (2) after surgery but before the OR cleaning and disinfection, and (3) after the OR cleaning and disinfection. In total, 1,520 environmental samples collected from 15 OR sites for 10 surgical patients at 3 time points were analyzed. Relatedness among environmental MRSA isolates was determined by pulsed-field gel electrophoresis. Results: Overall, the mean CFUs of aerobes per Rodac plate (CFU/25 cm2) were 10.1 before patient arrival, 14.7 before cleaning and disinfection, and 6.3 after cleaning and disinfection (P < .0001, after cleaning and disinfection vs before cleaning and disinfection). Moreover, 7 environmental sites (46.7%) after cleaning and disinfection, including bed, arm rest, pyxis counter, floor (near, door side), floor (far, by door), steel counter (small, near bed), and small computer desk, had significantly lower mean counts of aerobes than before patient arrival or before cleaning and disinfection (Fig. 1). The mean CFUs of MRSA per Rodac plate (CFU/25 cm2) were 0.04 before patient arrival, 0.66 before cleaning and disinfection, and 0.08 after cleaning and disinfection (P = .0006, after cleaning and disinfection vs before cleaning and disinfection). Of environmental sites where MRSA was identified, 87.2% were on floors (41 of 47) and 19.1% were after cleaning and disinfection (9 of 47, 8 from floors and 1 from pyxis touchscreen). The A2/B2 MRSA strain was identified on different environmental sites (eg, floor, computer desk, counter) in various rooms (eg, OR2, OR10, and OR16), even after cleaning and disinfection (Fig. 2). Conclusions: Our study has demonstrated that the OR environment was contaminated with aerobic bacteria and MRSA after surgery and that MRSA persisted in the environment even after cleaning and disinfection. Enhanced environmental cleaning in the perioperative environment used for patients on isolation is necessary to prevent transmission of healthcare-associated pathogens in ORs.Funding: NoneDisclosures: Drs. Rutala and Weber are consultants to PDI (Professional Disposable International)

scholarly journals Sunscreen or simulated sweat minimizes the impact of acute ultraviolet radiation on cutaneous microvascular function in healthy humans

2019 ◽  
Vol 104 (7) ◽  
pp. 1136-1146 ◽  
Author(s):  
S. Tony Wolf ◽  
Craig W. Berry ◽  
Anna E. Stanhewicz ◽  
Lauren E. Kenney ◽  
Sara B. Ferguson ◽  
...  
Keyword(s):  
Ultraviolet Radiation ◽  
Microvascular Function ◽  
Healthy Humans ◽  
The Impact
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